HomeMy WebLinkAbout12-13532 CITY OF ZEPHYRHILLS
5335-8TH SIREET
(si3)�so-oozo 13532
. � BUILDING PERMIT
Permit Number: 13532 Address: 39724 MEADOWOOD LP
Permit Type: ADDtTION/ALTERATION ZEPHYRHILLS, FL.
Ciass of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: MOORES FIRST ADDITION
Est. Value: Parcel Number: 13-26-21-0140-00000-0160
Improv. Cost: 916.00
Date Issued: 10/15/2012 Name: VERGARA, ALDO 8 HERRERA, VIRIDIA
Total Fees: 180.00 Address: 39724 MEADOWOOD LP
Amount Paid: 180.00 ZEPHYRHILLS, FL. 33542
Date Paid: 10/15/2012 Phone: 813)410-2349
Work Desc: CLOSE IN GARAGE CONVERT TO LIVABLE SPACE/INSTALL 3 WINDOWS
HOMEOWNER MECHANICAL FEE 60.00
HOMEOWNER
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FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection
trips are necessary due to any one of the following reasons: a)wrong address b)condemned work resulting
from faulty aonstruction c) repairs or corrections not made when inspections called d)work not ready for
inspection when called e) permit not posted on job site� plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of oommencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,oonsult with your lender or an attorney
before reoording your notice of oommencement."
Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
,
C SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: �lG� �er G�-ra � �i�/L�'�'� ��'`"��C�i��z��,
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Date Received: � ' �'-�Z—
Site: �� 7� � /�t`t�cG�G(�C�OG� ��
PermitType: (�S Q G'Cc.;�Ce ��Z� ��lrtS�� ��,Yl�(�C�
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Approved w/no comments:❑ Approved w/the below comments: � Denied w/the below comments: Q`�
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FORMS '
' FLORIDA BUILDING CODE,ENERGY CONSERVATI�ON
FORM 402-2010 Residential Building Thermal Envelope Approach ALL C�IMATE ZONES
Scape:Compliance with Section 402 of the florida Building Code,Enerpy Conservatioq shall be demonstrated by the use oi Form 402 for single-and multiple-family residences of three
stories or less in height,additions to existing residential buildings,renovations to existing residential buildings,new heating cooling and water heatinp systems in existing Euildings as
applicable.To comply,a building must.meet or exceed all of the energy efficiency requirements on Table 402A and all applicable mandatory requirements summanzed in Table 402B of this
form.If a building does not comply with this method or Alternate Form 402,it may still comply under Section 405 of the Florida Building Code,EnergyConservation.
PROJECT NAME: A�-D� VCIZG/FI� BUILDER: Q Wvtp_!-
ANDADDRESS: ,3�"7Z4 ME�OW� �� pERMITTING ��. J.. ("
ZEPNyRH-IU-S�FL 335y OFFICE: L� �� � J
OWNER:�(„pD V�� �� PERMIT NO.: 'J ,�� `y JURIS ICTION NO.: �p �� �
General Instructi ons:
1 New construction which inoorporates any oi the following features cannot comply using this method:glass areas in excess of 20 pe�ent of conditioned floor area,electric resistance
heat and air handlers located in attics.Additions<_600 sq.ft.,renovaifons and equipment changeouts may comply 6y this method with exceptions given.
2.Fill in all the applicable spaces of the'To Be Installed"column on Tabie 402A with the iniormation requested.All"To Be Instailed"values must be equal to or more efficient than the
required leveis.
3.Complete page 1 based on the"To Be Instalied"column information.
4.Read the requirements of Table 4026 and check each box to indicate your intent to comply with all applicable items.
5.Read,sign and date the"Prepared By"certiflcation statement at the bottom of page 1 The owner or owners agent must also sign and date the form.
Please Print CK
1. New construction,addition,or existing buiiding 1, j (pt-.,
2. Single-tamily detached or multiple-famiiy attached 2,���
3. If multiple-family-No.of units covered by this submission 3, --
4. Is this a worst case?(yes/no) q, t.10
5. Conditfoned floor area(sq.ft.) 5, �� �+
6. Glass type and area:
a.U-factor 6a. ���
b.SHGC 6b. •.Sd
c.Glass azea 6C. f 7 _sq.ft.
7. Percentage of glass to floor area � , 2� ,�a
8. Floor type,area or perimeter,and insulation: �
a.Slab-on-grade(R-value) $a.R= $ 7g kn.ft.
b.Wood,raised(R-value) 8b.R= sq.ft.
c.Wood,common(R-value) 8c.R= sq.ft.
d.Concrete,raised(R-value) Sd.R= sq.ft.
e.Concrete,common(R-value) 8e.R= s ft.
Q•
9. Wall type,area and insuiatton:
a.Exterior: 1. Masonry(Insulalion R-value) 9d-1. R= �O ���
sq.ft.
2. Wood frame(Hisulation R-value) 9a-2. R= Sq.ft.
b.Adjacent: 1. Masonry(Insulation R-value) 9b-1. R= sq.ft.
2. Wood frame(Insulation R-value) 9b-2. R=�� � sq.ft.
10. Ceiling type,area and insulation:
a.Under attic(Insulation R-value) 10a.R= �� sq.ft. ��
b.Single assembly(Insuladon R-value) 10b.R= Sq.ft.
11. Air distribution system:Duct insulation,location,Qn
a.Duct locazion,insulation 11 a. R= 8 �
b.AHLT location l i b. Ou-'S'S� -�
c.Qn,Test report attached(<0.03;yes/no) 11 c.Test report ettaChed? Yes �
12. Cooling system: C°`"'+'x'�
�.�,pe 12a.Type: S"�'Y�i�1�.�G vo(
b.Efficiency 12b.SEER/EER• �3
13. Heating system: 13a.Type:= «^-��'
a.Type 13b.HSPF/COP/AFUE: 7.�
b.Efficiency
14. HVAC sizing calculation:attached 14. Yes Jo
15. Hot water system: �
a.Type 15a.Type:
b.Efficiency 15b.EF•
I hereby certiry that theq and specifications cavered hy the calculation are in compliance with the Florida Review of plans and speciflcations covered by this IaUon hMjcates compliance with the Florida
Energy Code. I Enerpy Code.Before co�lctionis complefed, is building w�ilbe Inspected for compliance in
accordance wiih Sectian b53.908,F.S.,,F '�
PREPARED BY� � DATE. lv-�O��2 �� �f;:%
CODE OFFICIAL.
I hereby cert' at h' 'Id In co 'n e wi he orida Energy Gode: �O_`��lpL, -,
OWNER AGE �ATE• DATE: ,/�_�����" l
C.4 2010 FLORIDA BUILDING CODE-ENERGY CONSERVATION
FORMS
TABLE 402A �
BUILDING COMPONENT PERFORMANCE CRITERIA' INSTALLED VALUES:
U-Fedor<0.65
Windows(see Note 2): SHGC=0.30 U-Factor=
%ofCFA<=20% HGC=
5 li hts U-Factor<0.75 ot CFA=
Doors:Exterior door U-Factor U-Factor<0.65 U actor=
Floors: Slab-on-grade Norequirement R- elue=
Over unconditloned s aces see Note 3 R-13
Walls—Exl.end Adj.(see Note 3):
Frame R-73 R- lue=
Mass (see Note 3)
Interior of wall: R-7.8 R- lue=
Exteria of wall: R-6 R- ue=
Ceilings(see Notes 3&4) R=30 R- lue= Test report
Aeflectance 025 Pe tence= Attached7
Yes/No
Air distribution system(see Note 4)
Ductwork&air handling unit: Lo ation:
Uncond'Rioned space Not allowed Test report
Conditioned space Attached?
Ducl R-value R-value z 6 Yes/No i
Air leakage�n Qn s 0.03 R alue=
Q =
Air conditionin s stems see Note 5 SEER=13.0 ER=
Heating system
Heat pump(see Note 5) Cooling: SEER=13.0 EER=
Heating: HSPF=7 7 HSPF=
Gas fumace AFUE 78% AFUE_
Oil fumace AFUE 78% AFUE_
Electric resistance:Not allowed(see Note 5)
Water heafing system(storage type) "
Electric(see Note 6): 40 g . =0.92 Gallons=
50 gal:EF= EF=
Gas fired(see Note 7): 40 gal:EF=0.59 Gallons=
Other(tlescribe): 50 gal:EF=0.58 EF=
(1)Each component preseni in ihe As Proposed home must meet or exceed each of the applicable performance criteria in order to compiy with this code using this method;
otherwise Section 405 compliance must be used.
(2)Windows and doorsqualiying as glazed fenestration areas mustcomply with both the maximum U-Factorand the maximum SHGC(solarHeat Gain Coefficient)criteria
and have a maximum total window area equal to or less than 20%ot the conditioned floor area(CFA);othenvise Section 405 must be used for compliance.
Exception: Additions of 600 square feet(56 m2)or less may have a maximum glass to CFA of 50 percent.
(3)R-values are for insulation materiai only as applied in accordance with manufacturers'installation instructions.For mass walis,the"interiorof walP requirement must be
met except if at least 50%of the R-6 insulation required for the"exterior of wall"is instailed exterior of,or integrai to,the wall.
(4)Ducts 8 AHU instailed substantially leak free per Section 40322.1 Test by Class 1 BERS rater required.
Exception:Ducts instailed onto an existing air distribution system as part of an addition or renovation;duct must be R-6 installed per Sec.503.2.7.2.
(5)For all conventionai units with capacities greater than 30,000 Btu/hr For other types of equipment,see Tables 503.2.3(7-8).
Exception:The prohibition on etectric resistance heat does not apply to additions,renovations and new heating systems installed in existing buildings.
(6)For other electric storage volumes,minimum EF=0.97-(0.00132 x volume).
(7)For other natural gas storege volumes,minimum EF=0.67-(0.0019 x volume)
7ABLE 4028 MANDATORY REQUIREMENTS
COMPONENTS SECTION REQUIREMENTS CHECK
To be cauNced,gesketed,weathersMpped or otherwise seeled.Recessed lightfng IC-rated as meet(ng ASTM E ✓
Air leakege 402.4 283.Windows and doors=0.30 cfm/sq.ft.Testing or visual inspection required.Fireplaces:gesketed doors&
outdoor crombustion air.
Ceilingslknee walls 4052.1 R-19 spece pertnitting. �/
Progremmable thermostet 403.1.1 Where forced-air fumece is primary system,proprammable thertnostat(s required.
Air distribution system 403.2 Ducts in ettics or on roofs Insulated to R-8;other ducts R-6.Ducts tested to�,=0.03 by a Class 1 BERS rater. �/
Heat trep re�iretl for veNcal pipe risers.Compty wtth efficiencies in Teble 403.4.32.Provide switch or clearly
Water heaters 403.4 merked dreult breaker(electric)or ehutott(ges).Circulating system pipes insulated to=R-2+accessible manual
OFF switch.
Spas and heated pools must have vapor-retardent covers or e liqufd crover or other means proven to reduce heat
Swimming pool 8 spas 403.9 lass except H 70%of heat from site-recovered enerpy.OtNtlmer ewRCh required.Ges heaters minimum thertnat
eficf �7g% 82%efter 4/16/13.Heet um ol heaters minimum COP=4.0.
Sizing celculation pertortned 8 ettached.Minimum eficiencies per Tebies 5032.3.Equipmant effidency verification
Cooling/hea[ing equipment 403.6 recwired.Spedal occasion cooling or heeting capecily requires separete system or verieble capacity system.
Eiectric heet>10kW must be divkled Into two or more sta es.
Lighting equipment 404.1 At least 50%of pertnenently installed lighting fixtures shall be high-efficacy lemps.
2010 FLORIDA BUILDING CODE—ENERGY CONSERVATION C.5
OMZR130A LOWE'S HOME CENTERS, INC. PAGE: 1
ZPF 1854
PROJECT ESTIMATE BLOCK & WINDOW EST.
CONTAC�: VERGARA, ALDO SALESPERSON: STAFFORD, JOSEPH
CUST #: 106869990 SALES #: 1010943
PROJECT NUMBER: 358154025 DATE ESTIMATED: OS/27/12
QTY ITEM # ITEM DESCRIPTION VEND PART # PRICE
----- --------- ------------------------------ -------------------- ----------
100 10383 GRAY BLOCK 097083 115.00
12 10385 CONCRETE MIX 80# QUIKRETE 14104 46.20
1 315923 G5 ADHESIVE CARTRIDGE 08415 24.89
1 178587 53X50 VYL 10 SGL HNG GRID FL-3 145.00
6 13095 REBAR 5/8" X 10' (#5) 59.40
8 10353 CEMENT TYPE S MASONRY NA 61.20
1 12148 16 GA. TIE WIRE, 3 .5 LB. ROLL 306165 6.28
TOTAL FOR ITEMS 457.97
FREIGHT CHARGES 0.00
DELIVERY CHARGES 0.00
TAX AMOLTNT 3 2 .0 6
TOTAL ESTIMATE 490.03
This Quote is valid until 09/26/12.
MI�NAGER SIGNATURE DATE
THIS ESTIMATE IS NOT VALID WITHOUT MANAGER'S SIGNATURE.
THIS IS AN ESTIMATE ONLY. DELIVERY OF ALL MATERIALS CONTAINED IN THIS
ESTIMATE ARE SUBJECT TO AVAILABILITY FROM THE MANUFACTURER OR SUPPLIER.
QUANTITY, EXTENSION, OR ADDITION ERRORS SUBJECT TO CORRECTION. CREDIT
TERMS SUBJECT TO APPROVAL BY LOWES CREDIT DEPARTMENT.
LOWES IS A SUPPLIER OF MATERIALS ONLY. LOWES DOES NOT ENGAGE IN THE PRACTICE
OF ENGINEERING, ARCHITECTURE, OR GENERAL CONTRACTING. LOWES DOES NOT ASSUME
ANY RESPONSIBILITY FOR DESIGN, ENGINEERING, OR CONSTRUCTION; FOR THE
SELECTION OR CHOICE OF MATERIALS FOR A GENERAI. OR SPECIFIC USE; FOR
QUANTITIES OR SIZING OF MATERIALS; FOR THE USE OR INSTALLATION OF MATERIALS;
OR FOR COMPLIANCE WITH ANY BUILDING CODE OR STANDARD OF WORKMANSHIP.
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esia-�nu-vu[u t;ity ot Lephymiils Permit Application Fax-813-780-0021
Building Department
Date Recefved Phone Contact for Permittin C��,3 �0 __ Z-���
Owner's Name � � �'
� �� «- Y`!'��'� �- Owner Phone Number
� OwnePs Address � i-{- M w Owner Phone Number � —1
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
�OB ADDRESS "�tjp �� �I(�i �� �1� LOT� ��
�J
SUBDIVISION PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
IMORK PROP03ED B NEW CONSTR 8 ADD/ALT �� SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM �� OTHER
TYPE OF CONSTRUCTION Q� BLOCK Q FRAME 0 STEEL [�
I � a.._ " S �
DESCRiPTION OF WORK C l D s f,� , ,,,�,r �. �;y,r-� - �,r - ��l � L.,�i ��,J �
BUILDING SIZE SQ FOOTAGE HEIGHT
�✓]BUILDING S � VALUATION OF TOTAL CONSTRUCTION � ! ' `' �
QELECTRICAL � AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING a ,�
� (�353
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
OGAS Q ROOFING Q SPECIALTY �] OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER � � � COMPANY ��j'f �
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �—
ELECTRICIAN � � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREA Y/N
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREP Y/N
Address License#
L
MECHANICAL ae ' ` i COMPANY
SIGNATURE (/�� REGISTERED Y/ N FEE CURRE� Y/N
Address License#
OTHER � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
RESIDENTIAL Attach(2)Plot Plans;(2)sats of Buiiding Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Mfnimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary FaGlitles 8 1 dumpster;Site Work Permit for subdivfsionsAarge projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)w�orking days after submittal date. Required onsite,Construction Pians,Stormwater Plans w1 Silt Fence installed,
Sanitary Facilities 8 1 dumpster.Site Work Permit for all new proJects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Pians.
""•PROPERTY SURVEY required for all NEW constructlon.
Directions:
Fill out application completely.
Ovmer 8 Contractor sign back of appltcation,notarized
If over 52500,a NoNce of Commencement Is required. (AIC upgrades over 57500)
•• Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of AppllcaUon Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
which may be more �estrictive than County regulations. The undersigned assumes responsibility for complialnce:vith any
applicable deed restrictfons.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Divisfon—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
po�tions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that T�ansportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also unde�stands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "ce�tificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
finai power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713� Florida Statutes, as amended): If valuation of work is$2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner"prior to commencement.
CONTRACTOR'SIOWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions 1 must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environme�tal Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professiona) engineer
licensed by the State of Florida.
If the fiill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by flll, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSUL7
WITH YOUR L DER R AN TTO NE FO E E ORDI Y U T
FLORIDA JURAT(F.S. 117.03) '
OWNER OR AGEN � �- CUNTRACTOR + �
Subscrfbed and sworn o(ar a ) o e me th Subscribed and swom (o a me Is
by bY
Who is/are personally known to me or has/have produced Who Is/are personally known to me or has/have produced
as identlficadon. as Identlfication.
Notary Public Notary Public
Commissfon No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped